Monitoring of central corneal thickness after phacoemulsification—comparison of statical and rotating Scheimpflug pachymetry, and spectral-domain OCT

INTRODUCTION

Different measuring techniques have also been investigated and compared

All authors underlined poor comparability between different techniques while the consistency and reliability were high.

(3) 強風化泥灰巖(T1d)③：褐黃色，泥質成分，風化裂隙發育，巖芯多呈碎塊狀夾土狀，碎塊狀巖芯粒徑一般為1～5 cm，干時可用手折斷或捏碎，遇水易軟化，為軟巖，巖體基本質量等級為Ⅴ級，厚度0.9～6.9 m，分布不均勻。

The ultrasound energy needed to fragment the hard nucleus during cataract surgery strains the corneal epithelium

. A transient endothelial deterioration reduces the rate of intrastromal dehydration leading to an imbalance between influx of water from the anterior chamber into the corneal stroma and the active transportation of water into the anterior chamber by the corneal endothelium. This results in corneal swelling and thereby an increase in central corneal thickness (CCT)as an expression of endothelial decompensation. Extent and decrease of corneal swelling prove the endothelial recovery and compensation of its function

.

4.空氣濾清器罩排塵孔堵塞后空氣中塵粒排不出易堵塞下級濾網吸氣減少功率下降甚至塵粒進入燃燒室加快氣門缸套活塞等機件磨損。

Ultrasound pachymetry posed the gold standard for measuring the CCT for many years. Disadvantages of this method are poor reproducibility and dependency on the examiner in general

. On the other hand, sonography is a contact process, which can additionally affect the cornea which may be harmed by surgery already. Finally there is the toxicity of topical anaesthetic agents which are necessary for ultrasound pachymetry

.

“冰說”以韓同林、郭克毅為代表，他們認為，冰臼主要是由冰川融水(包括冰川壓融水)攜帶大量冰碎屑、巖屑及冰川粉物質，沿冰川裂隙自上向下以滴水石穿的方式形成滾流水鉆，對下伏基巖進行強烈的沖蝕和研磨作用下形成的。

Apart from ultrasound pachymetry a number of non-contacttechniques have been developed and established which are able to measure CCT

. The goal of this study was to evaluate the feasibility of different techniques to measure CCT in the perioperative course of uneventful cataract surgery using phacoemulsification.

Reliable and reproducible measurements which can be delegated to medical assistance personnel are desireable.The examination should be carried out quickly. For economic reasons the inclusion of corneal pachymetry into a multifunctional device is desireable. In this study modern noncontact-techniques for measuring the CCT were evaluated.Besides comparing three different devices, the feasibility of measurements was examined in a real-life-situation.

Economical aspects are becoming more and more important as many surgical units are performing 20, 30, 50 or even more cataract operations every day and postoperative care must be provided. This is an important issue as the resource “ophthalmologist/physician” is becoming scarce and sought after. So as many parts of the examination as possible have to be delegated to medical assistance personnel.

SUBJECTS AND METHODS

There were significant differences concerning repeated measures with both device and point of time (

-test).Significance with interaction in the last line points out that the profiles in the course of time were distinguishable for each device.

［本刊訊］上海市護理學會第九屆優秀論文評選活動已于近日順利結束。本屆評選活動共收到來自上海各級醫院、護理院校及部隊醫院等51家單位送評的近400篇護理論文，上海市護理學會學術專委會及有關專家經過初評、復評和終評后，最終評選出一等獎2篇、二等獎4篇、三等獎8篇、四等獎16篇及優勝獎30篇。具體獎項及獲獎名單詳見彩版插頁。

All surgical procedures were performed by the same surgeon(Handzel DM) using topical or parabulbar anaesthesia and a divide-and-conquer-technique through a 2.8 mm main incision.A foldable 1-piece-intraocular lens (IOL) was implanted in the capsular bag in all cases. Postoperatively dexamethasone/gentamycin-ointment was applied. The same medication was prescribed as eye drops in a tapered regime for the following 4wk.All selected patients underwent a comprehensive ophthalmological examination (U1) within 4wk prior surgery. This included objective refraction, best corrected visual acuity, tonometry,anterior segment Scheimpflug imaging, optical coherence tomography (OCT) of the anterior segment and if needed the macula, slit lamp examination and fundoscopy. The CCT was readout after using statical Scheimpflug imaging (NIDEK NT 530-P) which takes place during tonometry, rotating(Sirius) Scheimpflug photography and anterior segment-OCT(Topcon-2000).

Further examinations were performed on the first day postoperatively (U2), 3-6d postoperatively (U3), and 3-5wk postoperatively (U4). Besides a comprehensive postoperative clinical examination, CCT was measured at each visit.

An important aspect of this study was the comparability of the three devices under demanding–in this case perioperativecircumstances. Correlations of the results are given in Table 2.All bivariate correlations between the three devices were highly significant (

≤0.001) at (almost) every point of time. This implies good comparability of different devices at different points of time. An important exception can be seen with the Scheimpflug camera: the results of the Sirius device differed significantly from the other two devices at U2,compared to the OCT also with U3 (Tables 3 and 4).

The Scheimpflug camera Sirius (Fa. Costruzione Strumenti Oftalmici, Scandicci,Italy) is a new multifunctional device, which is also equipped with a Placido-system for corneal topography, infrared meibography, pupillography and tear film analysis.

A rotating Scheimpflug camera is acquiring 25 radial images of the cornea and the anterior chamber in 2-3s. The images are analysed and the results include tangential and sagittal curvature data for the anterior and posterior surface of the cornea, corneal refractive power, biometrical analysis of multiple structures of the anterior segment (anterior chamber volume, chamber angle

.), a calculation of the corneal wavefront and corneal pachymetry. The system is measuring 35 632 points on the anterior and 30 000 points on the posterior surface of the cornea during 5-6s. This data is calculated to a pachymetry map by version 1.0.5.72 of the Phoenix

software(Fa. Costruzione Strumenti Oftalmici, Scandicci, Italy).

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